黃志平^1,2、蕭子玄^1,2、張兆祥^1,2

1.中國醫藥大學附設醫院泌尿部; 2.中國醫藥大學醫學系

Chi-Ping Huang^1,2, Justin Ji-Yuen Siu^1,2, Chao-Hsiang Chang^1,2

 

The indications of partial nephrectomy have been expanding thanks to the advances in surgical technique and equipment. Robot-assisted laparoscopic surgery provides a magnified view of the surgical field and increased dexterity of the operator. We present a case of large renal tumor which might have undergone radical nephrectomy, but was cured using robot-assisted laparoscopic partial nephrectomy.

This 48-year-old male teacher presented with intermittent gross hematuria with blood clots for weeks. He has a past history of hypertension, but was otherwise healthy. CT scan showed a 9x8x8 cm left renal tumor enhanced by contrast medium, which was suggestive of renal cell carcinoma. We used a 4-arm robotic system with one 12 mm assistant port to perform partial nephrectomy. Warm ischemic time was 33 minutes 50 seconds, including the time used for anterograde double-J stent insertion. Robotic console time was 180 minutes. Estimated blood loss was about 700 ml and PRBC 2U was transfused. Floseal ® hemostatic matrix was applied to cut surface. Final pathology was renal cell carcinoma, clear cell variant, pT2aN0M0. Follow up at 19 months revealed no local recurrence or distant metastasis on CT scan, and serum creatinine was not significantly elevated.

Conclusions:

Robot-assisted laparoscopic partial nephrectomy may remove large renal tumors safely and effectively. Further studies are necessary to provide more concrete data on this treatment modality.